Do current national and international guidelines have specific recommendations for older adults with bipolar disorder? A brief report

TY - JOUR

T1 - Do current national and international guidelines have specific recommendations for older adults with bipolar disorder?

T2 - A brief report

AU - Dols, Annemiek

AU - Kessing, Lars Vedel

AU - Strejilevich, Sergio A

AU - Rej, Soham

AU - Tsai, Shang-Ying

AU - Gildengers, Ariel G

AU - Almeida, Osvaldo P

AU - Shulman, Kenneth I

AU - Sajatovic, Martha

AU - International Society for Bipolar Disorders Task Force for Older Adults with Bipolar Disorder

N1 - Copyright © 2016 John Wiley & Sons, Ltd.

PY - 2016/12/1

Y1 - 2016/12/1

N2 - Objective: Older adults with bipolar disorder (OABD) are a growing segment of patients with bipolar disorder (BD) for which specific guidelines are warranted. Although, OABD are frequently excluded from randomized controlled trials due to their age or somatic comorbidity, more treatment data from a variety of sources have become available in recent years. It is expected that at least some of this emerging information on OABD would be incorporated into treatment guidelines available to clinicians around the world. Methods: The International Society of Bipolar Disorders OABD task force compiled and compared recommendations from current national and international guidelines that specifically address geriatric or older individuals with BD (from year 2005 onwards). Results: There were 34 guidelines, representing six continents and 19 countries. The majority of guidelines had no separate section on OABD. General principles for treating OABD with medication are recommended to be similar to those for younger adults, with special caution for side effects due to somatic comorbidity and concomitant medications. Therapeutic lithium serum levels are suggested to be lower but recommendations are very general and mostly not informed by specific research evidence. Conclusions: There is a lack of emphasis of OABD-specific issues in existing guidelines. Given the substantial clinical heterogeneity in BD across the life span, along with the rapidly expanding population of older individuals worldwide, and limited mental health workforce with geriatric expertise, it is critical that additional effort and resources be devoted to studying treatment interventions specific to OABD and that treatment guidelines reflect research findings.

AB - Objective: Older adults with bipolar disorder (OABD) are a growing segment of patients with bipolar disorder (BD) for which specific guidelines are warranted. Although, OABD are frequently excluded from randomized controlled trials due to their age or somatic comorbidity, more treatment data from a variety of sources have become available in recent years. It is expected that at least some of this emerging information on OABD would be incorporated into treatment guidelines available to clinicians around the world. Methods: The International Society of Bipolar Disorders OABD task force compiled and compared recommendations from current national and international guidelines that specifically address geriatric or older individuals with BD (from year 2005 onwards). Results: There were 34 guidelines, representing six continents and 19 countries. The majority of guidelines had no separate section on OABD. General principles for treating OABD with medication are recommended to be similar to those for younger adults, with special caution for side effects due to somatic comorbidity and concomitant medications. Therapeutic lithium serum levels are suggested to be lower but recommendations are very general and mostly not informed by specific research evidence. Conclusions: There is a lack of emphasis of OABD-specific issues in existing guidelines. Given the substantial clinical heterogeneity in BD across the life span, along with the rapidly expanding population of older individuals worldwide, and limited mental health workforce with geriatric expertise, it is critical that additional effort and resources be devoted to studying treatment interventions specific to OABD and that treatment guidelines reflect research findings.

KW - Review

KW - Journal Article

U2 - 10.1002/gps.4534

DO - 10.1002/gps.4534

M3 - Review

C2 - 27442023

SN - 0885-6230

VL - 31

SP - 1295

EP - 1300

JO - International Journal of Geriatric Psychiatry

JF - International Journal of Geriatric Psychiatry

IS - 12

ER -